'Achieving closure?’ Improving outcomes when care homes close

Care homes for older people are a crucial service, supporting some 400,000 people 24 hours a day/365 days a year.

In an era of austerity, care markets are increasingly fragile, and the very logic of a market implies that the risk of failure has to be real for there to be sufficient incentives for providers to deliver appropriate care at the right price.

When care homes close –whether through financial problems, care failings or other factors – the received wisdom is that subsequent relocation can be detrimental to the well-being of older residents.

Despite this, there is little formal evidence to guide services when undertaking such sensitive work, with local areas reinventing the wheel each time a closure takes place/failing to share learning externally.

Building on a previous pilot study of care home closures in Birmingham, this study explores what happens to older people and care staff when homes close, how best to manage closures in a way that minimises negative outcomes for older people and families, and key lessons for Councils as they manage future closures.

The study asks: 1.What is the pattern of care home closures nationally, how are they undertaken in different Councils and what do Councils consider best practice when supporting older people at such potentially stressful times? 2.How do older people experience closures, what impact does closure have on health and quality of life, and how can negative impacts be reduced? 3.What impact do closures have on care staff and local care markets, and how can negative impacts be reduced? 4.What are the costs and consequences of closures, and key data required to make this estimation?

Can we develop a modelling framework to drive appropriate data collection for future home closure prediction to mitigate adverse outcomes? 5.How can future closures be planned and conducted in a more evidence-based manner, so that outcomes for older people are improved and negative impacts reduced?

To answer question the following approaches will be taken: 1.National survey of Directors of Adult Social Services, supplemented by CQC data 2.Four case study sites: Interviews with key stakeholders (commissioners, managers, Healthwatch, broader health partners) Interviews with older people, families, care staff and social work assessors during the closure process Outcomes data (EQ5D, ICECAP-O and outcomes identified in literature on what older people value about care services) at initial assessment, 28-day review and one-year follow-up 3.Survey of care staff (ProQOL) before and after closures, supplemented with individual interviews; interviews with local authorities (commissioners, social workers) and care home providers, supplemented with documentary analysis 4.Preliminary model-based economic evaluation comparing the costs and consequences of alternative pathways of care for residents when homes close (including costs for residents, families, staff and Councils) 5.The study will provide guidance to improve outcomes for older people, supported by key implementation partners, to ensure that future closures are conducted in a more evidence-based manner.

This includes a good practice guide for every DASS/CCG/Ambulance Trust in England; an accessible guide for older people/families; and a training video for care staff.